One of the biggest concerns that men have when having their prostates are removed to cure cancer, is the loss of erections. This is because the nerve bundles to the penis travel along the two sides of the prostate gland and can be easily damaged during surgery. Sometimes surgeons have to remove one or both nerve bundles to give the patient the best chance of successful removal of their cancer. Even when these nerves are spared, they take time and patience to recover because nerves are much slower to heal than other structures in our bodies.

I have started using a new technique of nerve sparing called SALINE ASSISTED FASCIAL EXPOSURE (SAFE) during robotic prostatectomy. This involves injecting saline with a tiny needle during surgery into the layers between the nerve bundles and the prostate. It allows the nerve bundles to be gently peeled off the prostate while minimising damage to them. It is simple, elegant and effective. Patients who have good erections before surgery have a higher chance of recovering them afterwards with the SAFE technique.

The latest results from New York comparing SAFE to standard nerve sparing (without SAFE) confirm that those having saline dissection of the nerve bundles have better erections at 6 weeks, 3, 6 and 12 months after robotic radical prostatectomy.